Cholera

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Cholera

• ???

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????? ? ????? ??????
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????? ? ????? ???????

• ?????? ??? ????? ?? ?? ??? ???????????
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• ?? ????? ?? ????? ????? ?? ??? ?????????? ??????
  ???????? ? ??? ??????? ???? ?? ????.

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CHOLERA
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John Snow Epidemiology
John Snow 1813-1858
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7th Cholera Pandemic El Tor
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Cholera case fatality rates
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Cholera and the aquatic environment
Cholera single org.
Cholera biofilm
Copepod
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Cholera Sea Surface Temperature
Bangladesh
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• Plankton concentrations during El Niño 82-83 in
  Bangladesh

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????????

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  ??? ?? ???? ???? ?? ??? ?? ????.
• ????? ? ???? ????? ??? ?????????????? ??
• O1 ? O139
• ?????????? ??? ???? ??????? ? ????? ????? ???? ??
  ????? ???? ?????? ??? ?????? ???
• ??? ????????? ???? ????? ?? ??? ?????????? ????
  ?????? ?? ??? ???????? ??????.

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(No Transcript)
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  ??????? ???????? ????? ??? ????.
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  ????? O1 ?? O6 ???? ???? ????? ???. ?? ???? ??
  ??? ?????????? ?? ???? O1 ???? ?? ????.

21

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  ?? ??????? ??? b?????gÿ???? ?? ???? ???? ???_at_?
  ???? ????? ??? ??? ?? ????? ???? ??? ?????? ??
  ?? ?? ???? ????? ???.

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?????? ?????

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  ?? ????. ?? ??? ????? ???? ???? ?? ???????? ??
  ???.

23
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  ????.
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  ?? ???? ????? ?? ???.
• ???? ??? ???? ????? ???? ????? ???? ????.

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??????? NAG

• ?????? ???? ?? ????? ??? ??? ????? ?? ???? ? ??
  ???? ??????? ???? O1 ????? ??? ?? ???? ??? O1
  ???????? ??? ????. ????? ???? ???????? ?? ??? ?
  ?????? ??? ?????? ???? ?????.

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  ?? ?? ?????? ?? ?? ??? ???? ?? ???? ??? ?? ?????
  ????? ???? ?? ??? 24 ???? ?? ??? ?? ???.( ?? ??
  ???? ?? ????? ???? ??? ?? ????)

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• ????? ?????? ??? ? ??????? ?? ?? ????? ??? ????
  ???.
• ?? ??? ???? ?? ???? 1 ?? ??? 5/2 ????? ?? ????.

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??????????? ??????
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• ???? ??????
• ??? ???? ?? ??? ??? ? ?????? 3-2 ???
• ??? ?????
• ?? ?? 12 ???? ?? 6 ??? ???? ????? ???? ????? ??
  ?? ????? ?????? ????? ( ?? ????? 100-20 ???? ??
  1)
• ???? 85 ???????? ???? ????? ?????? ???? ?? ?????
  ???? ?????.
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  ????? ??? ? ?? ? ??? ?? ???? ??? ????? ?? ? ???
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• ????? ???? ?? ??? 1 ???? ????? ?? ?????.
• ?? ????? ???? ??? ???? ?? 1 ???? ?? ???? ? ?? ???
  6 ???? ?? ?????????? ??? ?? 10 ??? ??? ? ??? ??
  18 ???? ???

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Clinical Features

• Incubation 18h 5 days
• Watery diarrhoea, infectious
• Vomiting
• 10 severe
• Up to 0.5-1 L/h ? dehydration

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?????? ?????????

• ?????? ?? ????? ??? ???
• 7 ?????? ?? ??? 1817 ?? 1961( ?? ?? ??? 1991 ??
  ??????? ????? ? ????? ????)
• ?? ???? ???? ?? ???.( 65 ???? ????? ???? ???? ??
  ??? 1997)
• ?? ??? 1991 595000 ???? ??? ?? WHO ????? ??? ???
  ?? ??????? ?? ?? ???? ?????? ???? ???.

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• O139 ???? ????? ??? ?? ??? 1992 ?? ????? ????
  ???.
• ?????? ???????????? ?? ???????? ???? ??? 0139 ?
  O1 ???? ????? ??? ?? ???? ?? ??? ????? ???? ????
  ?? 0139 ?? ????? ?????? ????? ????? ?? ?????????
  ????? ???.

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• ????? ?????? ????? ?? ??? 1344 ? ?? ?? ?? ????
  ???? ???? ? ?? ??? ?? ???? ????????? ? ?? ?? ???
  ??? ?????? ??? ???? ? ????
• 1349 1354
• 1355 1356
• 1358 1360
• 1364 1367
• 1368 1377
• 1377 10000 ????

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• 46-1344 ?????
• 3 ??? ??? ??????
• ?? ??? 1356 ?? ??? ?????? ?????? ? ?????
• ??? ?????
• ????? ????? ?? ????? ? ?? ?????? ?? ??? ? ??? 2/1
  
• ???? ???? ?????? ?? ?????? ????? ?? ???????? ????
  ??????

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?????

• ????? ???? 30/7 ?? 100 ???? ?? 1356?? 0/1 ?? 1375
  
• 1360-1368-1377 ??????
• ?? 1381 118 ???? ???? ????? ?? ?????? ?? ?? ????
  ???. ???? ??????? ????? ??????? ? ??? ???? ???.
• ?? 1384 1133 ???? ????? ?? 12 ???? ??? ? 837 ????
  ???(????? ?? ??? ???????? ?? ? ??????)

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(No Transcript)
36
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37
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  ???? ?????.
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  ????? ?? ?????
• ?? ????? ????? ????? ???? ???? ???? ?? ??? ?????
  ???? ?? ??? ????? ??.
• ????? ??? ????

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?????? ? ?????? ?? ????? ??????

• ??????? ????
• ??? ???????- ???????? ??? ?????
• ????? ?????? ????- cross immunity ??????.
• ???? ???? ??? ??? ????
• IgA ?? ?? ??????
• ?????? ?? ????? ??????
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• AB ?????? ??????? ?????.
• ??? ??????? ???? ?????? ?? ??????? ??? ??????
  ?????? ??? ?????? ??????? ?? ??? ?????? ?????.

40
????? ???? ??????

• ?? ????? ?? ???? ?? ??? ???? ????? ??? ???.( 5)
• ??? ?????? ????? ?? ????? ???? ?? ??? ???? ???
  ???.

41
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  ????? ( ???? ????? ????? ? ????)
• ???? ???? ????? 102 ?? 105
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  ?????? ?????
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?????? ??????

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  ????? ?? ??? ??? ?????
• ???
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43

• ???????? ??? ????? ??????? ???? ??? ?????.
• ?????? ???? ??? 70? ??? 90 ? ??? 98 ????? ??
  ??? ??? ????.
• ???? ?????? ??? ????? ???? ???.
• ????? ????? ?????? ?? ?? ?????? ??? ??? ??
  ??????? ????? ????? ????? ????? ????? ?? ???.
• ?????? ???? ?? ??? ?? 1000 ??? ?? ?? ????? ??????
  ??? ???? ?? ????. ???? ?? ?? ??? ??? ? ??? ?? ??
  ???? ?? ????.

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• ?? ????? ? ??? ??? ?? ?? ??? ????
• ????? ??? ?????? ?? ????
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  ?????) ?????? ???? ?? ????
• ???? ???????? ???? ?????? ???? ??? ????? ? ????
  ????? ?? ????.
• ?? ???? ???? ??????
• ????? ???? 102 ?? 105 ?? ?? ??? ?????
• 1011 ?????? ?? ????? ???? ???? ????? ??????
  ?????? ???? ???.

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TRANSMISSION

• Cholera is transmitted by the fecal-oral route
  through contaminated water food.

• Person to person infection is rare.

• The infectious dose of bacteria required to
  cause clinical disease varies with the source. If
  ingested with water the dose is in the order of
  103-106 organisms. When ingested with food, fewer
  organisms are required to produce disease, namely
  102-104.

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TRANSMISSION/2

• V. cholerae is a saltwater organism it is
  primary habitat is the marine ecosystem.

• Cholera has 2 main reservoirs, man water.
  Animals do not play a role in transmission of
  disease.

• V. cholerae is unable to survive in an acid
  medium. Therefore, any condition that reduces
  gastric acid production increases the risk of
  acquisition.

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HOST SUSCEPTIBILITY

• The use of antacids, histamine-receptor
  blockers, and proton-pump inhibitors increases
  the risk of cholera infection and predisposes
  patients to more severe disease as a result of
  reduced gastric acidity.

• The same applies to patients with chronic
  gastritis secondary to Helicobacter pylori
  infection or those who have had a gastrectomy.

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AT RISK GROUPS

• All ages but children elderly are more
  severely affected.

• Subjects with blood group O are more
  susceptible the cause is unknown.

• Subjects with reduced gastric acid.

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50
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51
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  ???? ????? ??? ????. ??????? ???? ?????.
• ??? ?????????? ???? ???? ???? ????? ??? ????.

52

• ????? ???? ?????? ?? ?? ????? 5 ??? ??? ?? ?????
  ???? ??? ???? ????? ???.
• ??? ?????????? ???? ????????
• ??? ?? ?? ??????? 2 ???? ?? ????? ??? ?? ?? ????
  ???? ?? ???.
• ??????????? 2 ??? ?? ??? ???? 3 ???
• ????? ??????? 300 ???? ??? ?? ??? ???? 3 ???
• ??????????? 100 ???? ??? ?? ?? 6 ???? ???? 3 ???

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?????

• ????? ???? ???
• ??????????? ?? ????????? ???? ??? ??????? ????? ?
  ?????
• 1- 5/0 ?? ?? ?? 2 ???? ?? ????? 4 ???? ????
  ??????
• 5 ??? ??? ?? ????? ??? ???? ???? ?? ??? ????? ?
  ?? 3 ??? ?? ?? ?????
• ????? ?? ?????? ?????? ??????? ?? ???? ?? ????
  ????? ??????? ????? ? ??? ???? ?????? ????? ??
  ?????? ??? ???.
• ??? ?? ???? ???? ?? ????? ?????? ??????? ?? ???.

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?????

• ???????? ???? ??? ??????
• ?? ???? ??? 5 ???? ???? ???? O ? ????? ?????
  ?????? ?????.
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• ??? ??????? ????? ????? ???? ????? ???.
• ?? ????? ?????? ??????? ????? ? ?????? ??????
  ?????? ? ???? ???? O ?? ??? ???? ????? ???.
• ?? ?? ??? ????? ????? ???? ??????? ?? ??? ?? ???.

55

• ??????? ???????
• ?? ???? ?????? ????? ?? ???? ?????? ?? ????? ????
  ??? ???? ? ??? ?????? ???? ????? ?? ??? ?????
  ???? ??? ???? ??? ?? ????????? ????? ???? ???
  ??????? ???? ???? ???? ????.(???????? ???? ??) ??
  ???? ????? ????? ??????
• ?? ???? ????? ?????? ???? ??? ?????? ???? ?????.
• ???????? ?????? ??????? ? ????? ???? ???????
  ???????

56
??????? ??????

• ?? ??????? ? ?? ??? ??????? ?? ?????? ????? ?? ?
  ???? ????? ??????? ?? ???.

57
??? ???? ? ?????? ????? ??

• ?? 24 ???? ??? ?????? ? ??? ?? ???? ???? ??????
• ?? ??????? ?? ???? ????? ?? ???? ??? ??? ?? ???
  ??? ??????? ? ?? ????? ?????? ??? ?? ?????
  ????(?????? 7 ???) ????? ?? ????????? ?????
• ????? ????? ?????? ?? ?? ????? ?? ??? ?? ???
  ?????? ???? ?????? ?? ?????

58
??????? ??? ???

• ????? ?????? ???? ??????? ???????? ?????? ???????
  ? ????? ????? ??? ??????????

59
??????? ?? ???????? ?????? ?? ? ?????? ??

• ????? ????? ??????? ??????
• ?????????????
• ??????? ?? ???? ???? ?? ?????- ??????? ? ??? ???
• ?? ????? ?????? ????? ??? ????????? ?? 1 PPM
  ??????
• ????? ????? ??????? ????? ??? ??? ??????
• ????? ?? ???? ??? ? ??????? ??????
• ????? ???
• ????? ????? ???? ???? ????? ??
• ??? ???? ??? ???? ??????? ????? ?? ?? ??? ?????

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• ??????? ?? ???? ?????? ??????? ? ???
• ?? ????? ?????? ????? ?? ????? ?? ? ???? ???? ??
  ??????? ???? ?????
• ????? ????? ???? ???? ????? ?? ?? ????? ?????
  ???? ?????? ???? ? ??? ????? O1 ? O139 ?? ??????
  ?? ??? ?? ?? ???? ?? ?????? ?????? ??? ??? ?? WHO
  ? ??????? ??????
• ??? ??????? ????? ?? ????? ??? ???.

61
FLUID THERAPY

• Ringer lactate solution is preferred over normal
  saline because it corrects the associated
  metabolic acidosis.

• IV fluids should be restricted to patients who
  purge gt10 ml/kg/h for those with severe
  dehydration.

• The oral route is preferred for maintenance
  the use of ORS at a rate of 500-1000 ml/h is
  recommended.

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DRUG THERAPY

• The goals of drug therapy are to eradicate
  infection, reduce morbidity and prevent
  complications.

• The drugs used for adults include tetracycline,
  doxycycline, cotrimoxazole ciprofloxacin.

• For children erythromycin, cotrimoxazole and
  furazolidone are the drugs of choice.

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DRUG THERAPY/2

• Drug therapy reduces volume of stool shortens
  period of hospitalization. It is only needed for
  few days (3-5 days).

• Drug resistance has been described in some areas
  the choice of antibiotic should be guided by
  the local resistance patterns .

• Antibiotic should be started when cholera is
  suspected without waiting for lab confirmation.

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